Provider Demographics
NPI:1346311503
Name:WALTERS, LAURIE S (OTR/L, CHT)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:S
Last Name:WALTERS
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19203 36TH AVE W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5757
Mailing Address - Country:US
Mailing Address - Phone:425-368-7943
Mailing Address - Fax:425-368-7443
Practice Address - Street 1:19203 36TH AVE W
Practice Address - Street 2:SUITE 103
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5757
Practice Address - Country:US
Practice Address - Phone:425-368-7943
Practice Address - Fax:425-368-7443
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOTOOO2391225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0276241OtherL&I
WA292144OtherL&I
WA0276242OtherL&I
WA0276246OtherL&I
WA0276246OtherL&I
WAG8899850Medicare PIN
WA0276242OtherL&I